Sunday Morning CPC Kids Registration - Centreville Presbyterian Church

CPC has infant and toddler child care on Sunday mornings as well as fun classes for 3 year olds through 5th graders. If you and your kids are planning to visit, this is the form you can fill out now or when you arrive.

Step 1: Parent or Guardian
Full Name*
Relationship to Child*
Email*
Birth Date*
MM slash DD slash YYYY
Cell Phone*
Does this parent/ guardian live at the address below?*
STEP 2 Address Information (primary residence of child)
Address*
Street Address City State ZIP Code
STEP 3 Child 1
Name*
First Last
Gender*
Birth Date*
MM slash DD slash YYYY
Grade
Allergies / Special Needs
Child 2
Name
First Last
Gender
Birth Date
MM slash DD slash YYYY
Grade
Allergies / Special Needs
Child 3
Name
First Last
Gender
Birth Date
MM slash DD slash YYYY
Grade
Allergies / Special Needs
STEP 4 Authorization
I understand and authorize that my child's image may be photographed and/or filmed and may be used in video, print and/or online publications including the church's website. By giving my email address, I understand that I will be added to Centreville Presbyterian Church's mailing list. CPC will not give your personal information to any third parties.

Step 1: Parent or Guardian

STEP 2 Address Information (primary residence of child)

STEP 3 Child 1

Child 2

Child 3

STEP 4 Authorization